Opinion: Access to care #1 issue according to BC’s Primary Care Citizen Panel

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As the cornerstone of our health care system, primary care is what supports all other areas of care. It provides Canadians with a reliable first point of contact for their health care needs, keeps our emergency departments looking after real emergencies and ensures that people’s health problems are addressed so they don’t get worse.

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But this solid foundation has been eroded for many years and we have all seen the negative impact of this on our loved ones and people in our communities.

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Last fall, our OurCare research team heard from more than 9,000 Canadians who responded to a survey about their experiences with family physician care and how they want the system to evolve to better meet their needs. We found that more than one in five adults in Canada don’t have a family doctor or nurse they can see regularly for care — and even those who do, struggle to get care on time.

People were open to doing things differently. For example, 90 percent said they would be comfortable with care from another member of the health care team if recommended by their family doctor. What mattered most to them was having a family doctor who knew them as a person and considered all the factors that affect their health.

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Over the past six months, we engaged 31 British Columbians (our “citizen panel”) who collectively invested nearly 1,000 hours of their time learning about the health system and considering challenges and opportunities to improve BC’s primary care system.

In their report, released on September 19, they outlined 25 clear and actionable recommendations that will change the way we think about and deliver primary care in BC.

Not surprisingly, access to care was the No. 1 issue our citizen panelists said needed to be addressed.

So what are the solutions to the access crisis?

Several are already underway: BC recently developed an innovative new family physician long-term funding model to support family physicians and their practices. The data suggests that as a result of these changes, there are already new family physicians practicing comprehensive family medicine, and we have heard stories of family physicians moving from other locations to practice here.

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While this is good news, we simply do not have enough doctors in BC to meet the demand for all the primary care we need. We are stretched not only in BC, but also everywhere in the world.

And because we don’t have enough doctors, we need innovation not only in funding models for doctors, but also to develop robust primary care teams that include nurse practitioners, nurse practitioners and mental health clinicians to ensure we can really deliver the care we all need and deserve.

The citizen panelists clearly recommended that team care is key to solving the challenges they face in trying to stay healthy.

Our citizen panelists specifically called for increased investment in community health centers (CHCs), which are community-led, multidisciplinary teams that include family physicians and other health professionals who work together in a coordinated manner to provide primary care. They believed that these CHCs should be deployed with equity in mind: First, they should be expanded to remote, indigenous, and low-income communities where we see the greatest challenges in accessing care.

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The panel acknowledged that there are patients who have difficulty understanding how to navigate multiple appointments, order their own lab tests, and coordinate many aspects of their care. Panelists felt that a valuable addition to healthcare teams would be the introduction of patient advocates who can ensure that no patient is left behind because of their health literacy, language barrier or difficulty navigating our complex healthcare system.

They also recommended major improvements in the technological aspects of primary care, from accessible electronic medical records to expanded virtual care capabilities.

They also recognized that no new investment or change can be adequately expanded or scaled without evaluation to understand its impact, outcomes and return on investment. They believe that there must be a system of robust and independent evaluation of primary care initiatives in BC and that efforts should be made to rapidly scale up and scale up effective programs and interventions at the community level.

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We have a chance to build a truly first-class primary care system in our province that can be the envy of Canada and the world. BC Citizens showed us where to start.

Goldis Mitra is a family physician and clinical assistant professor in the Department of Family Medicine at the University of BC Christie Newton is a family physician and associate professor in the UBC Department of Family Practice and president of the College of Family Physicians of Canada. Tara Kiran is a family physician and scientist at St. Michael’s Hospital, Unity Health Toronto and the Fidani Chair of Improvement and Innovation at the University of Toronto.

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